Impact of target-specific oral anticoagulants on transitions of care and outpatient care models.

Patients with acute or chronic illness experience transitions of care when they leave one healthcare setting and move to another. Care transitions are points of increased patient risk. Numerous care transition models have been developed that focus on improving the hospital discharge process to prevent adverse events after hospital discharge and to reduce readmission rates. Anticoagulants are a common cause of adverse drug events in hospitals, and of adverse events that lead to patient harm and hospital readmission. Anticoagulation management services improve the outcomes of anticoagulant therapy in both hospitalized and ambulatory patients. The services they provide, including improved communication, medication management, and patient education, are also central tenets of care transition models. These services have traditionally been focused around warfarin and heparin. Recently, new target specific oral anticoagulants have been approved in the US for various indications that traditionally have been treated with warfarin. These new agents are administered in fixed doses without the need for routine laboratory monitoring or frequent dosing adjustments. Yet as high risk drugs, they will require systematic efforts to assure their safety and minimize potential adverse events. These concerns are of particular importance during transitions of care. Anticoagulation management services, must be prepared to establish practices that improve patient outcomes regardless of the anticoagulant prescribed, using the established principals of care transition models.